Abstract
This study aimed to analyze the surgical and refractive outcomes of XEN glaucoma implant (Allergan, an Abbvie company, Irvine, CA, USA), a minimally invasive surgical device for the treatment of operated uncontrolled glaucoma. Eyes that received XEN Gel Stent placement from December 2014 to October 2019 were retrospectively investigated. Intraocular pressure (IOP) change, best-corrected visual acuity (BCVA), change in glaucoma medications, frequency of slit lamp revision procedures, and frequency of secondary glaucoma surgeries were the primary outcomes. Seventy-two eyes of 72 subjects were included in the study: 32 (44%) men and 40 (56%) women. The follow-up period ranged from 1 to 50 months (median, 26.13 months). The mean IOP before surgery was 24.82 ± 8.03 mmHg and decreased to 17.45 ± 5.84 mmHg at the end of the study (mean difference [MD] = −7.48, 95% confidence interval [CI]: −10.04, −4.93; p < 0.001). The mean decrease from baseline was 23%. BCVA before surgery was 0.38 ± 0.30, and that at the end of the follow-up period improved to 0.47 ± 0.37, MD = 0.09, 95% CI: 0.04, 0.13; p < 0.001. Additional procedures (fluorouracil injection and bleb needling) were performed in 11/72 patients (15%). Further glaucoma surgery was necessary for 23.9% of the patients. XEN Gel Stent implantation is both safe and reasonably effective for lowering IOP in operated uncontrolled glaucoma patients.
Highlights
Glaucoma remains the second leading cause of blindness worldwide [1], and the only known factor that can slow the progression of this disease is the reduction of intraocular pressure (IOP)
Refractory glaucoma cases usually present with neovascular glaucoma (NVG), congenital glaucoma or juvenile glaucoma (GJ), postinflammatory glaucoma (UG), traumatic glaucoma (TG), or glaucoma resulting from previous vitreoretinal procedures
Seventy-two eyes of 72 subjects were included in the study (32 [44%] men and 40 [56%] women). e mean age of patients at the time of surgery was 59.51 ± 18.22 years. e duration of the subjects’ glaucoma ranged from 12 months to 56 years. e mean follow-up period was 26.87 ± 15.33 months
Summary
Glaucoma remains the second leading cause of blindness worldwide [1], and the only known factor that can slow the progression of this disease is the reduction of intraocular pressure (IOP). Despite advanced pharmacological and surgical treatments, many cases of glaucoma progress to blindness [2]. Operated uncontrolled glaucoma (OUG) poses a challenge for glaucoma surgeons [3]. It is defined as an uncontrolled IOP with associated visual field deterioration, despite maximum tolerated antiglaucoma treatment and previously unsuccessful antiglaucoma procedures [4]. E term refractory glaucoma (RG) usually refers to the patients after at least 2 trabeculectomies with or without a cyclodestructive procedure. Refractory glaucoma cases usually present with neovascular glaucoma (NVG), congenital glaucoma or juvenile glaucoma (GJ), postinflammatory glaucoma (UG), traumatic glaucoma (TG), or glaucoma resulting from previous vitreoretinal procedures (oil-induced glaucoma)
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